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OPTIONAL: This information will help insure the project gathers input from a range of people. These <br />categories are used so the project can compare survey results to Census data. <br /> <br />1. Where do you live? <br /> River Road <br /> Santa Clara <br /> Rural Santa Clara (outside UGB) <br /> Other: _____________ <br /> <br />2. What is your age? <br /> 17 and under <br /> 18 – 24 <br /> 25 – 39 <br /> 40 – 59 <br /> 60 and over <br /> <br />3. How many people live or stay in your <br />home? <br /> 1 <br /> 2 <br /> 3 <br /> 4+ <br /> <br />4. Do children or teenagers (17 and under) live <br />in your household? <br /> Yes <br /> No <br /> <br />5. What is your gender? <br /> Male <br /> Female <br /> Another gender identity <br /> <br />6. Do you experience a disability? <br /> Yes <br /> No <br /> <br /> <br /> <br /> <br />7. Do you have access to an automobile? <br /> Yes <br /> No <br /> Yes, but not on a regular basis <br /> <br />8. Select all races/ethnicities you identify with: <br /> American Indian or Alaska Native <br /> Asian <br /> Black or African American <br /> Hispanic, Latino, or Spanish origin <br /> Middle Eastern or North African <br /> Native Hawaiian or Other Pacific <br />Islander <br /> White <br /> Another race/ethnicity <br /> Please list any other race(s) or <br />ethnicity(ies) here: <br /> <br /> <br /> <br />9. Please estimate your total household <br />income for 2017 before taxes. <br /> Less than $35,000 <br /> $35,000-$74,000 <br /> $75,000 + <br /> I don’t know <br /> <br />November 19, 2018, Work Session – Item 2